AwakeNurseMama Intake Form

Name: *

Phone Number: (Yes, it’s me texting not a bot. 😂 I promise not to spam you!) *

Click here to consent to me texting you reminders before our meeting.*

Yes, I am fine with you sending me text reminders before our meeting.No, please do not send me text reminders.

What questions would you like answered?

What are your goals for our one-hour call?

Will you need exemption help? If yes, please elaborate.

Informed Consent & Medical Guidance Educational Session

You are booking a one-hour, one-on-one Zoom call with me. This session is designed to provide educational information regarding informed consent, vaccines, or other medical procedures. We will discuss your rights as a parent or individual, particularly in professional settings. I can also help guide you on medical exemptions, providing resources and information during this time.

Please note, this session is for educational purposes only and does not constitute medical or legal advice. By signing below, you agree that I am not held liable for any medical decisions you make for your health or your children's health, no legal action will be taken against me now or ever after signing this legal contract. I will also suggest natural remedies and treatments I personally use for my own family with no dosage information .

After the session, I will provide you with additional educational resources and help you with any exemption-related information via email.

You consent to pay $100 for this educational session. Payment will be made via Venmo and must be completed prior to the session. Any future sessions will be booked separately at an additional cost. My Venmo is @kristenw28 last 4 is 8103.

Signature consent to agree this is not medical advice, legal consent with signature that no legal action will be taken, and that payment is due at time of service.

Schedule Your 1:1 Consultation With Me!

I will send an email reminder, so please let me know the best email to reach you.*

example@example.com